Piperacillin-tazobactam versus cefepime incidence of acute kidney injury in combination with vancomycin and tobramycin in pediatric cystic fibrosis patients

LeCleir, Lisa K.; Pettit, Rebecca S.

doi:10.1002/ppul.23718

Cited by 31 publications

(32 citation statements)

References 13 publications

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“…A recent study compared the incidences of AKI among children with cystic fibrosis treated with vancomycin and tobramycin in combination with either TZP or cefepime and found a higher incidence of AKI in the TZP group than in the cefepime group (55% vs 13%, respectively; P < .0001) [21]. As previously mentioned, Downes et al [14] published the results of a retrospective cohort study that compared the incidences of AKI among pediatric patients receiving vancomycin in combination with either TZP or another antipseudomonal β-lactam antibiotic.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Nephrotoxicity Among Pediatric Patients Receiving Vancomycin With Either Piperacillin–Tazobactam or Cefepime: A Cohort Study

Cook

Gillon

Grisso

et al. 2018

Journal of the Pediatric Infectious Diseases Society

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Section: Discussionmentioning

confidence: 99%

Incidence of Nephrotoxicity Among Pediatric Patients Receiving Vancomycin With Either Piperacillin–Tazobactam or Cefepime: A Cohort Study

Cook

Gillon

Grisso

et al. 2018

Journal of the Pediatric Infectious Diseases Society

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“…After adjusting for age, sex, concomitant nephrotoxins, vancomycin dose, and antibiotic indication, the hazard ratio to develop AKI when treated with VPT was 2.9 (95% CI 1.3–6.1) [23]. Studies in cystic fibrosis [26] and hematology/oncology patients [27] yielded similar results. However, 2 large studies in critically ill children had conflicting results.…”

Section: Introductionmentioning

confidence: 93%

Nephrotoxicity from Vancomycin Combined with Piperacillin-Tazobactam: A Comprehensive Review

et al. 2021

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Background: Recent studies have identified the combination of vancomycin with piperacillin-tazobactam (VPT) to be associated with increased nephrotoxicity. Multiple, large cohort studies have found this widely used combination to have a higher risk of nephrotoxicity than other regimens in a variety of populations. Summary: This review summarizes the epidemiology and clinical features of VPT-associated acute kidney injury (AKI). Potential mechanisms involved in the pathogenesis of this phenomenon are also discussed. Key Message: VPT-associated nephrotoxicity is a recently recognized clinical entity. Clinical strategies to minimize the risk of toxicity in this setting include antimicrobial stewardship, monitoring of kidney function, and emerging data supporting the potential role for novel biomarkers in predicting and managing AKI.

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“…Adult and pediatric studies suggest that administration of vancomycin and TZP simultaneously confers an increased risk of AKI compared with vancomycin alone, TZP alone, and when compared with use of vancomycin and another b-lactam antibiotic. [8][9][10][11][12][13][14][22][23][24][25][26][27] Assessment of this medication combination has shown varying results in the critically ill population. [28][29][30] Our study is the largest to date that specifically evaluates the association between individual and concomitant administration of vancomycin, TZP, and cefepime with subsequent development of AKI in critically ill children ( Figure 2).…”

Section: Discussionmentioning

confidence: 99%

Piperacillin/Tazobactam and Antibiotic-Associated Acute Kidney Injury in Critically Ill Children

Joyce

Kane‐Gill

Priyanka

et al. 2019

JASN

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BackgroundThere continues to be uncertainty about whether piperacillin/tazobactam (TZP) increases the risk of AKI in critically ill pediatric patients. We sought to compare rates of AKI among critically ill children treated with TZP or cefepime, an alternative frequently used in intensive care units, with and without vancomycin.MethodsWe conducted a retrospective cohort study assessing the risk of AKI in pediatric intensive care unit patients after exposure to vancomycin, TZP, and cefepime, alone or in combination, within 48 hours of admission. The primary outcome was development of stage 2 or 3 AKI or an increase in AKI stage from 2 to 3 within the 6 days after the 48-hour exposure window. Secondary outcomes included lengths of stay, need for RRT, and mortality.ResultsOf 5686 patients included, 494 (8.7%) developed stage 2 or 3 AKI. The adjusted odds of developing AKI after medication exposure were 1.56 for TZP (95% confidence interval [95% CI], 1.23 to 1.99), 1.13 for cefepime (95% CI, 0.79 to 1.64), and 0.86 for vancomycin (95% CI, 0.69 to 1.07). The adjusted odds of developing AKI for vancomycin plus TZP versus vancomycin plus cefepime was 1.38 (95% CI, 0.85 to 2.24).ConclusionsObservational data in critically ill children show that TZP use is associated with increased odds of AKI. A weaker, nonsignificant association between vancomycin plus TZP and AKI compared with vancomycin plus cefepime, creates some uncertainty about the nature of the association between TZP and AKI. However, cefepime is an alternative not associated with AKI.

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Piperacillin-tazobactam versus cefepime incidence of acute kidney injury in combination with vancomycin and tobramycin in pediatric cystic fibrosis patients

Abstract: AKI occurred in nearly 55% of patients with piperacillin-tazobactam therapy versus 13% of patients with cefepime therapy, which suggests cefepime may be preferred in combination with vancomycin and tobramycin for pediatric CF patients.

Cited by 31 publications

References 13 publications

Incidence of Nephrotoxicity Among Pediatric Patients Receiving Vancomycin With Either Piperacillin–Tazobactam or Cefepime: A Cohort Study

Incidence of Nephrotoxicity Among Pediatric Patients Receiving Vancomycin With Either Piperacillin–Tazobactam or Cefepime: A Cohort Study

Nephrotoxicity from Vancomycin Combined with Piperacillin-Tazobactam: A Comprehensive Review

Piperacillin/Tazobactam and Antibiotic-Associated Acute Kidney Injury in Critically Ill Children

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